A SUCCINCT ACCOUNT OF THE PLAGUE AT MARSEILLES,
Its Symptoms, and the Methods and Medicines used for Curing it.
And presented to the Governor and Magistrates of Marseilles, by M. Chicoyneau, Verney and Soullier, the Physicians who were sent thither from Paris by the Duke Regent of France, to prescribe to the Sick in the Hospitals, and other Parts of that Town, during the Progress of that Calamity.
Translated from the FRENCH by a Physician.
Printed for S. Buckley in Amen-Corner, and D. MIDWINTER at the Three Crowns in St. Paul's Church-Yard. M.DCC.XXI.
The following Relation having been sent to us by Messieurs Chicoyneau, Verney and Soullier, deputed by the Court for the Relief of our City afflicted with the Plague: We Charles Claude de Andrault de LANGERON, Knight and Commander of the Order of St. John of Jerusalem, Chief Commander of the King's Galleys, Field Marshal, and Marshal of his Majesty's Armies, Commandant in the City of Marseilles, and the Territories thereof.
Alphonsus de Fortia Marquis de PILLES, Governing Magistrate, and John-Baptiste Estelle, John Baptiste Audimar, John-Peter Moustier, and Balthazar Dieude, Sheriffs, Protectors and Defenders of the Privileges, Franchises and Liberties of this City, Counsellors of the King, and Lieutenants General of the Police, have thought fit to cause it to be printed; for having been Eye-witnesses of the Zeal with which these Gentlemen have exposed themselves for the Service and Relief of our Sick, as well in the City as in the Hospitals, we are thoroughly persuaded that their Observations on the Nature of this fatal Malady, and on the Remedies proper to its Cure, cannot but be very useful to the Inhabitants of divers Places of this Province that are unfortunately infected.
At Marseilles this 26 Nov. 1720.
A SHORT RELATION OF THE SYMPTOMS OF THE PLAGUE AT MARSEILLES,
Its PROGNOSTICKS and METHOD OF CURE.
To give some Satisfaction to the just Expectations of very many Persons, as well of this Realm as of foreign Countries, who fearing the dismal Effects of the Contagion, have done us the Honour to request of us some Account of the Nature of the Distemper that has depopulated Marseilles, and of the Success of such Remedies as we have employed against it; we have thought fit to draw up the following Relation, containing in short what is most essential in this Affair, and which may be sufficient to intelligent Persons of the Faculty, to direct their Conduct, and help them in framing a Judgment in the like Case, till we have better Means and a more convenient Leisure to present to the Publick more exact Particulars of all that we have observed on this Subject.
All the Diseased that we have seen or attended, in this terrible Distemper, commonly called the Plague, may be reduced to five principal Classes; which will take in generally all the Cases that we have observed, except a few particular ones, which cannot be brought under any general Rule.
The First Class, observed especially in the first Period, and in the greatest Fury of the Distemper, contains such as were afflicted with the Symptoms that we shall here set down, constantly followed by a speedy Death.
These Symptoms were for the most part irregular Shiverings, the Pulse low, soft, slow, quick, unequal, concentrated; a Heaviness in the Head so considerable, that the sick Person could scarce support it, appearing to be seized with a Stupidity and Confusion, like that of a drunken Person; the Sight fixed, dull, wandering, expressing Fearfulness and Despair; the Voice slow, interrupted, complaining; the Tongue almost always white, towards the end dry, reddish, black, rough; the Face pale, Lead-coloured, languishing, cadaverous; a frequent Sickness at the Stomach; mortal Inquietudes; a general sinking and Faintness; Distraction of the Mind; dosing, an Inclination to vomit, Vomiting, &c.
The Persons thus seized, perished commonly in the Space of some Hours, of a Night, of a Day, or of two or three at farthest, as by Faintness or Extinction; sometimes, but more rarely, in convulsive Motions, and a Sort of Trembling; no Eruption, Tumour or Spot appearing without.
It is easy to judge by these Accidents, that the Sick of this kind were not in a Condition to bear Bleeding; and even such, on whom it was tried, died a little while after.
Emeticks and Catharticks were equally here useless, and often hurtful, in exhausting the Patient's Strength, by their fatal over-working.
The Cordials and Sudorificks were the only Remedies to which we had recourse, which nevertheless could be of no Service, or at the most prolong the last Moments but for a few Hours.
The second Class of the Diseased that we attended during the Course of this fatal Sickness, contains such as at first had the Shiverings, as the preceding, and the same sort of Stupidity, and heavy Pain in the Head; but the Shiverings were followed by a Pulse quick, open, and bold, which nevertheless was lost upon pressing the Artery ever so little. These Sick felt inwardly a burning Heat, whilst the Heat without was moderate and temperate; the Thirst was great and inextinguishable; the Tongue white, or of an obscure red; the Voice hasty, stammering, impetuous; the Eyes reddish, fixed, sparkling; the Colour of the Face was of a red sufficiently fresh, and sometimes inclining to livid; the Sickness at the Stomach was frequent, tho' much less than in those of the preceding Class; the Respiration was frequent, laborious, or great and rare, without Coughing or Pain; Loathings; Vomitings, bilious, greenish, blackish, bloody; the Courses of the Belly of the same Sort, but without any Tension or Pain; Ravings, or phrenetick Deliria; the Urine frequently natural, sometimes troubled, blackish, whitish, or bloody; the Sweat, which seldom smelt badly, and which was far from giving Ease to the Sick, that it always weakned them; in certain Cases Hemorrhages, which, however moderate, have been always fatal; a great Decay in the Strength, and above all, an Apprehension so strong of dying, that these poor Creatures, were incapable of any Comfort, and looked on themselves, from the first Moment of their being attacked, as destined to certain Death. But that which deserves to be well observed, and which has always seemed to characterise and distinguish this Disease from all others, is, that almost all had at the Beginning, or in the Progress of this Distemper, very painful Buboes, situated commonly below the Groin, sometimes in the Groin or Arm-pits, or in the Parotide, Maxillar, or jugular Glands; as likewise Carbuncles, especially on the Arms, Legs or Thighs, small, white, livid, black Pustles, dispersed over all the Surface of the Body.
It was very rare to see any of the diseased of this Second Class escape, though they supported themselves a little longer than those of the preceding; they perished almost all with the Marks of a gangren'd Inflammation, especially in the Brain and Thorax; and that which was most singular is, that the stronger, fatter, fuller, and more vigorous they were, the less we had to hope.
As to the Remedies, they bore Bleeding no better than those of the First Class; at least if they were not blooded at the very first Instant of their being taken Sick: It was evidently hurtful to 'em; they grew pale, and fell even in the time of their first Bleeding, or a little while after, into such Faintings, as could not in most of them be imputed to any Fear, Repugnance, or Distrust, since they demanded with Earnestness to have a Vein opened.
All Emeticks, if we except Ipecacuanha, were very often more hurtful than useful; causing such fatal Irritations and Excesses in operating, as we could neither moderate or stop.
The Catharticks that were a little strong and active, were attended with the same Inconveniences.
Such as we prescribed in the Form of a laxative Ptisan, as well as plentiful Draughts, that were diluting, nitrous, cooling, and gently alexiterial, gave some Relief, but did not hinder the Return of the Symptoms.
All Cordials and Sudorificks, if they were not soft, gentle and benign, did nothing but promote the Progress of the inward Inflammations.
In short, if any one escaped, which was very rare, he seem'd to owe his Cure to the external Eruptions, when they were very much raised; either solely by the Force of Nature, or by the Assistance of Remedies, as well internal as external, that determined the Blood to discharge on the Surface of the Body, the noxious Ferment wherewith it was infected.
The Third Class contains the two preceding; seeing we have attended, during the Course of this terrible Sickness, a great Number of Persons that have been attacked successively with the different Symptoms enumerated in the two former Classes, in such a manner, that the most part of the Signs described in the Second, were commonly the Forerunners of those which we have mentioned in the First; and the appearing of these latter Symptoms denounced an approaching Death.
In these sorts of Cases we varied our Method according to the diversity of Indications, or of the most urgent Symptoms; so that without our being obliged to enter into farther Particulars, a Judgment may be formed of the Event of this Malady, and of the Success of the Remedies, from what we before observed on the Subject of the diseased of the two preceding Classes.
Before we pass on to the Fourth Class, we believe it will not be improper to observe, that a very great Number of different Kinds of diseased Persons contained in the preceding, had very moderate Symptoms, whose Force and Malignity appeared to be much less, than in those of the same Accidents daily observed in inflammatory Fevers, or in the most common putrid ones, or in those that are vulgarly called Malignant, if we except the Signs of Fear or Despair, which were Extream, or in the highest Degree; insomuch, that of the great Number of infected Persons who have perished, there were very few, who at the very first Moment of their being seized, did not imagine themselves lost without Relief, whatever Pains we took to encourage them: And though many amongst them seemed to us, before the first Access of the Distemper, to be of a firm and courageous Disposition of Mind, and resolute under all Events, yet as soon as they felt the first Strokes, it was easy to know by their Looks, and their Discourses, that they were convinced that their Sickness was Incurable and Mortal, even at the Time when neither the Pulse, nor the Tongue, nor the Disorder in the Head, nor the Colour of the Face, nor the Disposition of the Mind, nor lastly, the Lesion of any of the other natural Functions mentioned above, gave any fatal Indication, or before there were any Grounds to be allarmed.
The fourth Class contains the Diseased attacked with the same Symptoms with those of the second, but these sorts of Accidents lessened or disappeared the second or third Day of themselves, or in Consequence of the Effects of the internal Remedies, and at the same time in Proportion to the remarkable Eruption of the Buboes and Carbuncles in which the noxious Ferment that was dispersed through the whole Mass, seemed to be collected together; so that the Tumours rising from Day to Day, at length being open, and coming to a Suppuration, the Infected escaped the Danger that threatned them, provided they had some Assistance.
These happy Events have determined us to redouble our Care during the whole Course of this Sickness, to accelerate, as much as the State of the Patient will admit, the Eruption, Elevation, Opening, and Suppuration of the Buboes and Carbuncles, in order to free, as soon as possible, by this way, the Mass of Blood, from the fatal Ferment that corrupts it; aiding Nature by a good Regimen, and by such cathartick, cordial, and sudorifick Medicines, as are proper in the present Condition and Temperature of the Sick.
FIFTH and LAST CLASS.
This Fifth and Last Class contains all such infected Persons, as without perceiving any Emotion, or there appearing any Trouble or Lesion of their natural Function, have Buboes and Carbuncles, which rise by little and little, and easily turn to Surpuration, becoming sometimes scirrhous, or which is more rare, dissipate insensibly, without leaving any bad Effect behind them; so that without any loss of Strength, and without changing their manner of Living, these infected Persons went about the Streets and publick Places, only using themselves a simple Plaister, or asking of the Physicians and Surgeons such Remedies as are necessary to these sorts of suppurating or scirrhous Tumours.
The Number of the infected contained in the two last Classes, were so considerable, that one may affirm, without any exaggeration, that more than fifteen or twenty Thousand Persons were found in these sorts of Cases; and if the Distemper had not often taken this turn, there would not have been left in this City the fourth Part of its Inhabitants.
We may very well admit a Sixth Class of such as we have seen perish without any Forerunner, or other manifest Hurt, than only a decay in Strength; and who being asked concerning their Condition, answered, that they were not sensible of any Disorder, which for the most part denoted a desperate Case, and an approaching Death; but the Number of these were very small in Comparison of such as made up the preceding Classes.
Besides all these Observations, it has happened that amongst so great a Number of infected Persons, we have seen many particular Cases, wherein, contrary to our Expectation, and all the Appearance of Reason, the Sick have perished or recovered; but we are of Opinion that it would be useless to relate them here, and to give of them a long and tedious Account; being moreover persuaded that these Sorts of particular Events can serve as no sure Rule to form a Prognostick, or how to proceed in the like Distemper. It is therefore more proper to keep to the Observations we have made, and that the rather, since they are found conformable to those of our Collegues who have laboured in concert with us in this so painful and dangerous Work; and who have always professed to relate what they have seen and observed themselves, without suffering themselves to be prejudiced by all the Reports that a vain Credulity, a popular Superstition, the Boastings of Empericks, and the Greediness of making Profit by the publick Calamity, have spread through this City.
To conclude, the Medicines we have made use of are such, whose Efficacy and manner of Operation, are generally acknowledged by a long Experience, to be adapted to satisfy all the Indications reported above; having moreover not neglected certain pretended Specificks, such as the solar Powder, the mineral Kernes, Elixirs, and other alexiterial Preparations, as have been communicated to us by charitable and well-disposed Persons; but Experience itself has convinced us, that all these particular Remedies are at the most useful only to remove some certain Accidents, when at the same time they are often noxious in a great many others, and by consequence incapable to cure a Disease characterised by a Number of different essential Symptoms.
AN ABSTRACT OF THE
Different Methods that have been used towards the Infected, as they are included in the FIVE CLASSES mentioned above.
Having finish'd the preceding Relation the Tenth of November, and applying to the Magistrates to procure Writers to copy a sufficient Number, to satisfie the Desires of all the Persons who have done us the Honour to consult us on this Subject, those Gentlemen replied, that by reason they could not get Transcribers enow, they would willingly take upon themselves the Care of having it printed; so that we have accepted their Offer, being persuaded that it is the shortest and most commodious Expedient to answer to all the Consultations that we receive from all Quarters on this Subject; but having reflected that this same Relation would be of no Use but to Persons of the Faculty who are instructed and experienced in the Knowledge and Cure of Diseases, we have thought proper to add here an Abstract of the different Methods which we have made use of in treating the different Kinds of diseased Persons contained in the five Classes mentioned above; presuming that they may be of Service to the young Physicians and Surgeons that are actually engaged in looking after infected Persons in divers Places of this Province. And we are the more readily determined to give this small Instruction to the Publick; since Mons. LEBRET, first President of the Parliament, and Intendant of this Province, a Gentleman zealous for its Preservation, and very active in his Assistance in this time of Calamity, has done us the Honour frequently to ask of us an exact Account of the Treatment of this Malady.
The Method used in treating the Sick of the First Class.
If we afford but the least Attention to the Nature of the Symptoms related in the first Class, that is to say, to the small, unequal, and concentrated Pulse; to the Shiverings; to the universal Chilliness, especially in the extreme Parts, and to the almost continual Sickness at the Stomach; to those Lead-coloured, dismal and cadaverous Faces; it will be very easy to judge, that we have nothing to do in this Case, but to prescribe the most active and generous Cordials; such as are Venice Treacle, Diascordium, the Extract of Juniper Berries, the Lilium; the Confection of Hyacinth, of Alkermes; the Elixirs drawn from Substances that abound the most in a volatile Salt; the Treacle Waters, those of Juniper Berries of Carmes; the volatile Salts of Vipers, of Armoniack, of Hartshorn; the Balms the most spirituous; in one Word, all that is capable to animate, excite and strengthen; augmenting, doubling, and even tripling their ordinary Dose, according as the Case shall be more or less pressing.
All these Remedies, and others of the same Nature, are without doubt very proper to animate and raise the almost extinguished Strength of these poor sick Persons; nevertheless we have with Grief seen almost all of them perish on a sudden, which presently confirmed us in the Opinion generally received, that the Malignity of the pestilential Ferment is of a Force superior to all Remedies; but as we have also seen them succeed in some particular Cases, there is Room to presume, and one is but too much convinced of it by fatal Experience, that the Desertion and Inactivity of the greatest Part of the People who might have given Assistance, that the Want of Nourishment, of Remedies and Attendance, that the fatal Prejudice of being seized by an incurable Distemper, that the Despair of seeing ones self abandoned without any Relief, one is, I say, well convinced that all these Causes have not less contributed than the Violence of the Disease, to the sudden Destruction of so great a Number of the Sick, not only of this first Class, but also of the following; seeing that in Proportion as this mortal Fear of the Contagion is diminished, and that one is mutually assisted, that the Hopes and Courage of the People are returned; that, in one Word, the good Order is re-established in this City by the Authority, Firmness and Vigilance of the Chevalier de LANGERON, by the great Care of the Governor, and by the constant and indefatigable Endeavours of the Sheriffs; one has beheld the Progress and Violence of this terrible Scourge to diminish insensibly, and we have been more successful in curing the infected.
Returning then to the Method proposed to treat the sick Persons of this First Class, supposing that by the Remedies mentioned, we were able to revive their dying Forces, and to disengage them from the sad Condition described above, it would remain to examine with Attention the new Changes and Accidents that would arise, which according to our Observations, may be reduced to some of those we have related under the following Classes, and ought by consequence to be treated by some of the Methods which we shall now deliver.
The Method used in treating the Sick of the Second Class.
The Treatment of the Sick of this Second Class has much more employed us than the preceding, in respect to the Multiplicity and Variety of Accidents that offer at the same time several Indications to satisfy.
All these Indications, however, may be reduced to two principal ones, which demand the greater Attention and Prudence, since they are opposite; for we have observed in the same Patient a strange mixture of Tension and Relaxation, of Shivering and Heat, of Agitation and Sinking; insomuch, that we were obliged constantly to endeavour at the expulsion of the noxious Ferments lodged in the primae Viae, or dispersed through the whole Mass of Blood, without exasperating them at the same time; or to correct and lessen their Action, without weakening the Patient. We ought, for Example, to vomit or purge without irritating or exhausting; to procure a free Perspiration or Sweating, without too much animating or inflaming; to fortify without augmenting the Heat contrary to Nature; lastly, to dilute and temperate without overcharging or relaxing. And this is what we have endeavoured to execute by the following Method.
Suppose that we were called at the Beginning, and before the Patient was exhausted, we should order immediately a Medicine proper to cleanse the Stomach, that is to say, a gentle Vomit, such as is the Ipecacuanha, in a Dose proportioned to the Age and Temperature of the sick Person, to be taken in a little Broth or common Water; we have seldom used the Emetick Tartar or Vinum Benedictum, for fear of too great Irritations, unless we had to do with very robust and plethorick Bodies, or that some particular Accident seemed to demand them; we promoted the Operation of the Medicine by a large quantity of warm Water, or of Tea, or a Decoction of Carduus Benedictus.
The Effect of this first Medicine being commonly a lessening of the Strength, we endeavoured to fortify, by some gentle Cordial, especially by Venice Treacle and Diascordium, by reason they are proper to prevent or stop an over-working of the Vomit.
To these two Remedies succeed moderate and diluting Catharticks, to cleanse away without irritating the Load of gross Humours which may hinder the Action of the other Medicines, or prevent their free Passage into the Vessels: These Purges are laxative Ptisans, made with Sena and Crystal Mineral, ordered in Phials; the Decoction of Tamarinds, or vulnary Infusions, wherein are dissolved Manna and Sal Prunel; the Diluta-Cassiae; Syrupus de Chichorco cum Rhab.; to which then succeed the Cordials and gentle Alexipharmacks, for the Reasons given above; that is to say, to fortify, and to stop the Over-purgings, which would infallibly cause some fatal Weakness: And supposing that the Venice Treacle and Diascordium were insufficient to answer this last Indication, we would add sealed Earth, Coral, Bole-Armoniack, which we would render still more efficacious in Cases of Necessity, by the mixture of some Drops of liquid Laudanum, which has been of service in many Cases, not only in stopping the immoderate Evacuations, but even in the want of Sleep, phrenetick Deliria, Hemorrhages, and other Symptoms of the same sort.
The Solar Powder of Hamburgh, the Mineral Kermes, and other Remedies that have been communicated to us with great Commendations, have been also used, both as Emeticks and Catharticks; and have sometimes with success, answered both those Indications: And at the same time, in some certain Cases, we observed they promoted Sweat and Perspiration; but as we have already remarked, they have always seemed to us insufficient to perform the Work of a radical Cure, in a Distemper characterised by divers essential Symptoms.
For what relates to Sudorificks, as soon as we perceive the least Disposition to a free Transpiration or Sweating, in what time soever of the Sickness it happens, we have taken care to make use of them, and that the rather, by reason some infected Persons have escaped by this Method: Nor are we ignorant how this sort of Crisis is recommended as very Salutary by all the Authors that have wrote of the Plague: We have had therefore Recourse to some of the Cordials mentioned above, and particularly the Venice Treacle and Diascordium; to which may be added the Powder of Vipers, Diaphoretick Antimony, Oriental Saffron, Camphire, &c. promoting the Effect of these Medicines by the repeated Draughts of Tea, the vulnerary Infusions of Switzerland, the Waters of Scabious, Carduus Benedictus, Juniper Berries, of Scordium, Rue, Angelica, and others, recommended for pushing from the Center to the Circumference; that is to say, to depurate the Mass of Humours by the way of insensible Perspiration without too much Emotion; observing always, that the Patients are not of a too dry and hot Constitution, or that in forwarding too much this Sort of Crisis, they do not fall into some fatal Weakness.
The great Heats and intolerable Thirst are allayed by a plentiful and repeated drinking of Water, wherein Bread has been macerated, Ptisan of Barley, of Rice, Chicken-Broth, dissolving therein Sal Prunel, or purified Nitre, mixing by intervals a few Drops of Spirit of Sulphur, or of Nitre dulcified, or of Vitriol; as also the Confections of Alkermes, Syrup of Lemons, de Ovo, or any other gentle Cordial, to prevent an Over-charge and Relaxation.
All these Remedies properly made use of, and managed with Prudence, are sufficient to satisfy the divers Indications of this second Class, provided the terrible Prejudice of the Impossibility of a Cure, the Consternation, and the Despair, do not suspend their Action: And we could, if the Time would permit, give several Instances of such, as being supported by their Hopes, Courage, and Firmness, have experienced the good and wholsome Effects thereof: So that Nature being thereby strengthened, comforted, and freed in part, of the noxious Ferment that oppressed her; and above all, being delivered from the Danger of the internal Inflammations, by the means of the external Eruptions, I mean the Carbuncles, Buboes, Parotides, &c. there remains nothing to be done, but to treat methodically these sorts of Tumours, to which we have particularly applied our selves from the beginning of the Distemper to the end; and that with the greater Diligence, by reason, as we have already remarked, the Destiny of the Patient depended almost always on the Success of these sorts of Eruptions, the manner of treating which, we shall give by and by, according their several Varieties.
The Method used in treating the Sick of the THIRD CLASS.
It would be altogether needless to enter into the particulars of the Method we used in treating the Patients of this third Class, since the Symptoms they were attack'd with, were the same with those which we have mention'd in the two preceeding Classes; so that they succeeded mutually each other, and the Symptoms related in the second Class, were the Forerunners of those described in the first; whence it is easy to judge that we have here nothing to do but to use successively the Medicines mentioned before. The Observation that we thought fit to insert between the third and fourth Class, and in which it is shown, that several infected Persons perished in a very short Time with Symptoms very moderate, or much less violent than what we generally observe the same Symptoms to be in malignant or common putrid Fevers. This Observation, I say, may instruct us, that this Sort of infected Persons in whom often there only appear a small Weakness, and a very great Consternation, demands as much Care as those in whom the Symptoms are more considerable, and on the least Appearance of their being seized, there ought immediately to be used, besides generous Remedies, every Thing that is proper to sustain their Strength and encourage them.
The Method of treating the Sick of the FOURTH CLASS.
We have nothing here to do, but to cast our Eyes back, on what we have said above, relating to the Accidents that characterise and terminate the Plague, in order to judge that this Method should principally turn on the Manner of treating the Buboes or Carbuncles. The Symptoms, it is true, that appear at the Beginning in the Diseased of this Class, are nearly the same with those that show themselves in the sick Persons of the second Class; so we immediately employ'd the Remedies proper to oppose them, such as are the gentle Emeticks, the diluting Catharticks and Sudorificks of the same sort, according to the Indications that arise, observing however a very exact Regimen. But the Destiny of the Infected, depending principally, as we have remarked already, on the large Emption, and laudable Suppuration of the Buboes and Carbuncles, these Sorts of Tumours have been always the Objects of our chief Care and Attention. And since these Tumours have constantly appeared in the Sick of this fourth Class, and in those of the preceeding, the Method which we are going to propose for their Management, ought to be consider'd, as common to all the Classes.
The Method used in the Treatment of Buboes.
These Tumours were ordinarily situated in the Groin, and often below it, chiefly swelling the lymphatick Glands, placed near the crural Vessels; they appeared also pretty frequently under the Arm-pits, particularly under the pectoral Muscle, as also in the Glands behind and below the Ears, in the Jugular, and under the Chin.
The Buboes with which the Sick of the former Classes were attack'd, often appeared at the Beginning of the Distemper, chiefly in the Groin and Arm-pits, small at first, deep and exceeding painful, that one could scarce touch or handle them, without causing a very uneasy Sensation; these for the most Part made no other Alteration in the Skin, but by swelling it, as they grew bigger, towards the End they became indolent.
In what Time soever of the Distemper these Sorts of Tumours appeared, we attacked them without any Delay, unless there was Reason to presume from other Symptoms that the sick Person was at the Point of Death.
If the Tumour was small, deep, painful, and one had Time to endeavour to mollify it, we began with the Application of emollient and anodyne Cataplasms, and as the Misery and Desertion would not suffer us to have Recourse to choice Drogues, we prepared on the Spot, and applied warm, a Sort of Pultice composed of Crums of Bread, common Water, Oil of Olives, Yolk of an Egg, or a large Onion roasted in the Ashes, which we first hollowed, and filled with Treacle, Soap, Oil of Scorpions or of Olives; using moreover, for Persons of Condition, Cataplasms made with Milk, the Crummy Part of Bread, Yolks of Eggs; or with the Mucilage of emollient Herbs and Roots.
But as the Diseased of the first Classes perish often very suddenly, even at the Time when we apprehend such an Accident the least, we think it not adviseable in this Case to prescribe such Sort of Applications; but we ought immediately to prevent the last Danger, by endeavouring at the opening of the Tumour, and to that End we caused to be applied without Delay, all over the Part a Dressing with the caustick Stone, leaving it there for some Hours, more or less, according to the Depth, Situation, Bulk of the Parts, and the Constitution fat or lean of the Patient; the Escarr being made, it must be opened by Incision, without any Delay, in order to examine the tumified Glands, to dissolve which, there ought to be apply'd Digestives, after they have been a little scarified; or they should be extirpated if they are moveable, and can be removed without an Hemorrhage, which according to our Observations has been always fatal tho' but moderate. And for this Reason we have thought fit to reject the Method of extirpating these Tumours, which was made use of before we came to this City. The Way of opening them immediately by a Lancet, altho' more ready than that by Cauteries, appears to us in many Cases insufficient, and less sure, as giving but little Light to view the Part, and leaving very often after it, Abscesses, Fistula's or Scirrhous Tumours. As to Cupping, Glasses and Blisters, their Effects seem to us slow, useless, and that of the Latter sometimes dangerous; in certain Subjects their Application has been followed by internal Inflamations, especially in the Bladder.
Returning then to our Caustick Stone, the Escarr being formed, and the Incisions made with the Precaution of discovering the tumified Glands, in their whole extent, that no bad Reliques be left behind; the next Thing is to dissolve the Glands by the means of good Digestives, which may be made of equal Parts of Balsom of Arcaeus, Ointment of Marsh-Mallows, of Basilicon, adding thereto Turpentine and Oil of St. John's Wort, which ought to be well mixed, and if there is any remarkable Corruption in the Part, there ought to be joyned with the Turpentine and Oil of St. John's Wort, the Tinctures of Myrrh, of Aloes, Spirit of Wine camphorated and Sal Armoniack; lastly deterging and cleansing away the Pus and Sanies, whilst it is thick and too corrosive, with Lotions made of Barley Water, Honey of Roses, Camphire; or with vulneraine Decoctions of Scordium, Wormwood, Centaury the less, and Birthwort. And when the Ulcer has been well deterged, and the tumified Glands entirely consumed by Suppuration, there remains nothing but to apply a simple Plaister to bring the Wound to a Cicatrice.
We shall now give in few Words, the Method we used in the Cure of Carbuncles, which in many Circumstances have a near Relation to the preceeding.
The Method used in the treating Carbuncles.
We have observed these sort of Tumours during the whole Course of the Sickness, in a very great number of diseased Persons in all the Classes, though less frequent than the Buboes; remarking also very often in the same Subjects, these two sorts of Emptions.
The Carbuncles present themselves in different Places on the Surface of the Body, especially in the Thighs, Legs, Arms, Breast, Back, but very rarely in the Face, Neck, or Belly.
They appear at first under the Form of a Pustle or Tumour, which is whitish, yellowish, or reddish, Pale in its middle, or inclining to an obscure Red, which becomes insensibly blackish, crustaceous, especially about the Edges; as also variegated with divers Colours; so that, according to that which is predominant, and the Excess or Defect of Sensibility and Elevation, we may give it the Name of a Phlegmonick, Erysipelatous, or gangrened Carbuncle.
We immediately attack all these sorts of Carbuncles by Scarification, making the Incision to the Right and to the Left, in the Middle, and on the Edges, to the Quick; and if the Escarr is Thick and Callous, we take away all the Thickness, and what is Callous, as much as the Situation of the Parts will permit.
We have not thought proper to use here the actual or potential Cauteries which are employed in our Province, in the case of common Carbuncles, because, having made Trial of them at the Beginning, we observed that they caused Inflammations so considerable, that a Gangrene presently ensued, and its Edges became Callous again: The Caustick Stone succeeded not but in small Carbuncles, which heal of themselves, almost without any Help.
After having scarified these Tumours, we applied Pledgets with good Digestives, as in the Case of Buboes, only with this Difference, that we have left out the suppurating Ingredients, using only the Treacle, Balsam of Arcaeus, and Oil of Turpentine; and if there is much Corruption, we add the Tinctures of Aloes, of Myrrh and Camphire, &c.
We put over the Pledgets, emollient and anodine, or spirituous and dissolving Cataplasms, as over the Buboes, according to the diversity of Indications. In the Course of the Dressings, the Lotions and Injections are also employed the same as for the Buboes, according to the Exigence of the Case. And, if in the Process of Suppuration, the new Flesh be so sensible, that the Digestives applied cause a very great Pain, as we have seen it often happen, then we substitute in their room Pledgets with Unguentum Nutritum, with very good Success.
The Method relating to the Sick of the FIFTH CLASS.
We believe it will be useless to give every particular of the Method that has been followed, and which is still actually used in the Cure of the diseased of the Fifth Class, wherewith the Hospitals are filled; because they being afflicted with no other Symptom besides the Buboes and Carbuncles ill looked after, or neglected, and by consequence, nothing here offers it self but the Abscesses, Ulcers, Fistula's, Scirrhus's, and Callus's, which Negligence, or an ill Treatment have left behind them; so that there is here nothing farther required, but to put in Use the Method laid down above, or to employ the Means practised in the like Cases, according to the Rules of Art.
We shall remark, in concluding, that all the Methods we have here proposed, are not so general, or constant, as to be without Exceptions, in respect to certain particular Cases, which have fallen under our Observation during this terrible Sickness, and which may furnish Materials for a more exact Account. But what we have already delivered may be sufficient to instruct the young Physicians and Surgeons, that are employed in attending Infected Persons; and at the same time, to let the Publick know what Opinion ought to be had of all those singular Methods, and of those pretended Specificks so cried up by the Populace, and by the Empericks.
Long "s" has been modernized.
The following misprints have been corrected: "MARSELLIES" corrected to "MARSEILLES" (page 5) "funish" corrected to "furnish" (page 38)